口蓋裂の修復に及ぼすジグザグ口蓋形成術の効果とSommerlad Palatoplastyおよび二重対向Z Palatoplastyとの比較検討

The Effect of Zigzag Palatoplasty on the Repair of Cleft Palate and its Comparative Study With Sommerlad Palatoplasty and the Double Opposing Z Palatoplasty.

• Kun Wang
• Qian Wang
• Wei He
• Fang Wang
• Shang Chen
• Nini Zhang
• Qinggao Song

抄録

目的:

現在、口蓋裂の修復には様々な手術法がありますが、著者らは最初に鼻粘膜筋組織のジグザグ形成術を考案しました。この方法は、従来の方法に比べて口蓋咽頭の解剖学的・機能的に優れた修復効果が得られることが特徴である。

PURPOSE: At present, there are a variety of surgical methods for cleft palate repair, the authors first created the zigzag plasty of nasal mucosa musculature. The method is characteristic of better repair effect for anatomy and function of palatopharyngeal compared with the traditional method.

方法:

本研究では50名の口蓋裂患者を対象に、鼻粘膜筋膜修復のためのジグザグ口蓋形成術（n"Zs_200A"="Zs_200A"17）、Sommerlad palatoplasty（n"Zs_200A"="Zs_200A"18）、二重対向Z palatoplasty（n"Zs_200A"="Zs_200A"15）の3つの異なる手術法で治療を行った。術前と術後の軟口蓋長（切歯からぶどう膜先端までの距離）とぶどう膜から後咽頭までの距離を転帰指標とした。また、術後の発話明瞭度、鼻声共鳴、鼻漏についても評価した。

METHODS: Fifty patients with cleft palate were involved in this study, and treated with 3 different operative methods, respectively: zigzag palatoplasty for the repair of nasal mucosa myometrium (n = 17), Sommerlad palatoplasty (n = 18) and the double opposing Z palatoplasty (n = 15), respectively. The length of soft palate (the distance from incisor to the tip of uvula) and the distance from uvula to posterior pharynx before and after operation were selected as outcome index. The post-operative speech intelligibility, nasal resonance, and nasal leaking were also evaluated.

結果:

その結果、ジグザグ口蓋形成術、二重対向Z口蓋形成術、ゾンメルラッド口蓋形成術で軟口蓋の長さがそれぞれ14.50％、13.23％、10.10％増加し、3種類の手術の垂直先端から後咽頭壁までの距離がそれぞれ49.03％、47.78％、49.03％減少した。音声明瞭度、鼻声共鳴評価、鼻声共鳴評価の群間/群間比較では有意な差は認められなかった。

RESULTS: The results showed that the lengths of soft palate were increased by 14.50%, 13.23%, 10.10% with the zigzag palatoplasty, the double opposing Z palatoplasty and Sommerlad palatoplasty, respectively; the distances from the vertical tip to the posterior pharyngeal wall of 3 kinds of operation were reduced by 49.03%, 47.78%, 49.03%, respectively. The comparison of speech intelligibility, nasal resonance and nasal resonance assessment between/among groups were not significant.

結論:

著者らの研究では、ジグザグ口蓋形成術の効果は鼻粘膜筋膜の修復に有効であり、口蓋裂の機能的修復のオプション法として使用できることが示された。

CONCLUSION: The authors' research showed that the effect of zigzag palatoplasty works well in the repair of nasal mucosa myometrium and can be used as an optional method for functional repair of cleft palate.